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Cost-Effectiveness Analysis of Fecal Microbiota Transplantation for Recurrent Clostridium difficile Infection

Published online by Cambridge University Press:  02 January 2015

Raghu U. Varier ,
Eman Biltaji ,
Kenneth J. Smith ,
Mark S. Roberts ,
M. Kyle Jensen ,
Joanne LaFleur  and
Richard E. Nelson
Raghu U. Varier*
Affiliation:
Department of Pediatrics, University of Utah, Salt Lake City, Utah NW Pediatric Gastroenterology, LLC, Portland, Oregon
Eman Biltaji
Affiliation:
Department of Pharmacotherapy, University of Utah, Salt Lake City, Utah
Kenneth J. Smith
Affiliation:
Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
Mark S. Roberts
Affiliation:
Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
M. Kyle Jensen
Affiliation:
Department of Pediatrics, University of Utah, Salt Lake City, Utah
Joanne LaFleur
Affiliation:
Department of Pharmacotherapy, University of Utah, Salt Lake City, Utah
Richard E. Nelson
Affiliation:
Department of Internal Medicine, University of Utah, Salt Lake City, Utah
*
Address correspondence to Raghu U. Varier, DO, MSc, NW Pediatric Gastroenterology, LLC, 300 N. Graham St., Suite 420, Portland, OR (r.u.varier@gmail.com).
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Abstract

OBJECTIVE

Clostridium difficile infection (CDI) places a high burden on the US healthcare system. Recurrent CDI (RCDI) occurs frequently. Recently proposed guidelines from the American College of Gastroenterology (ACG) and the American Gastroenterology Association (AGA) include fecal microbiota transplantation (FMT) as a therapeutic option for RCDI. The purpose of this study was to estimate the cost-effectiveness of FMT compared with vancomycin for the treatment of RCDI in adults, specifically following guidelines proposed by the ACG and AGA.

DESIGN

We constructed a decision-analytic computer simulation using inputs from the published literature to compare the standard approach using tapered vancomycin to FMT for RCDI from the third-party payer perspective. Our effectiveness measure was quality-adjusted life years (QALYs). Because simulated patients were followed for 90 days, discounting was not necessary. One-way and probabilistic sensitivity analyses were performed.

RESULTS

Base-case analysis showed that FMT was less costly ($1,669 vs $3,788) and more effective (0.242 QALYs vs 0.235 QALYs) than vancomycin for RCDI. One-way sensitivity analyses showed that FMT was the dominant strategy (both less expensive and more effective) if cure rates for FMT and vancomycin were ≥70% and <91%, respectively, and if the cost of FMT was <$3,206. Probabilistic sensitivity analysis, varying all parameters simultaneously, showed that FMT was the dominant strategy over 10, 000 second-order Monte Carlo simulations.

CONCLUSIONS

Our results suggest that FMT may be a cost-saving intervention in managing RCDI. Implementation of FMT for RCDI may help decrease the economic burden to the healthcare system.

Infect Control Hosp Epidemiol 2014;00(0): 1–7

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 4 , April 2015 , pp. 438 - 444
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

This work has been presented at Digestive Disease Week (DDW) 2014, May 3–6. Abstract #1896750 accepted February 11, 2014. Poster Presentation, Sa1282.

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